Accuracy of telepsychiatric assessment of new routine outpatient referrals

<p>Abstract</p> <p>Background</p> <p>Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews.</p> <p>Method</p> <p>This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings.</p> <p>Results</p> <p>The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement.</p> <p>Conclusion</p> <p>Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals.</p

A systematic review of economic analyses of telehealth services using real time video communication

Background: Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area. Methods A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded. Results 36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study. Conclusion Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care

A review and framework for the evaluation of pixel-level uncertainty estimates in satellite aerosol remote sensing

Recent years have seen the increasing inclusion of per-retrieval prognostic (predictive) uncertainty estimates within satellite aerosol optical depth (AOD) data sets, providing users with quantitative tools to assist in the optimal use of these data. Prognostic estimates contrast with diagnostic (i.e. relative to some external truth) ones, which are typically obtained using sensitivity and/or validation analyses. Up to now, however, the quality of these uncertainty estimates has not been routinely assessed. This study presents a review of existing prognostic and diagnostic approaches for quantifying uncertainty in satellite AOD retrievals, and it presents a general framework to evaluate them based on the expected statistical properties of ensembles of estimated uncertainties and actual retrieval errors. It is hoped that this framework will be adopted as a complement to existing AOD validation exercises; it is not restricted to AOD and can in principle be applied to other quantities for which a reference validation data set is available. This framework is then applied to assess the uncertainties provided by several satellite data sets (seven over land, five over water), which draw on methods from the empirical to sensitivity analyses to formal error propagation, at 12 Aerosol Robotic Network (AERONET) sites. The AERONET sites are divided into those for which it is expected that the techniques will perform well and those for which some complexity about the site may provide a more severe test. Overall, all techniques show some skill in that larger estimated uncertainties are generally associated with larger observed errors, although they are sometimes poorly calibrated (i.e. too small or too large in magnitude). No technique uniformly performs best. For powerful formal uncertainty propagation approaches such as optimal estimation, the results illustrate some of the difficulties in appropriate population of the covariance matrices required by the technique. When the data sets are confronted by a situation strongly counter to the retrieval forward model (e.g. potentially mixed land–water surfaces or aerosol optical properties outside the family of assumptions), some algorithms fail to provide a retrieval, while others do but with a quantitatively unreliable uncertainty estimate. The discussion suggests paths forward for the refinement of these techniques